| NPI | 1578531216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME129920) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101231639) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: VA 0101231639) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: VA 0101231639) | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: VA 0101231639) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-06-18 |